An evaluative analysis of the practice of teamwork in Health and Personal Social Services

This report describes the practice of teamwork as expressed in case conferences for care of the elderly and evaluates the effectiveness of case conferences in their contribution to care. The study involved the observation of more than two hundred case conferences in sixteen locations throughout the West Midlands, in which one thousand seven hundred and three participants were involved. Related investigation of service outcomes involved an additional ninety six patients who were interviewed in their homes. The pu`pose of the study was to determine whether the practice of teamwork and decision-making in case conferences is a productive and cost effective method of working. Preliminary exploration revealed the extent to which the team approach is part of the organisational culture and which, it is asserted, serves to perpetuate the mythical value of team working. The study has demonstrated an active subscription to the case conference approach, yet has revealed many weaknesses, not least of which is clear evidence that certain team members are inhibited in their contribution. Further, that the decisional process in case conferences has little consequence to care outcome. Where outcomes are examined there is evidence of service inadequacy. This work presents a challenge to professionals to confront their working practices with honesty and with vision, in the quest for the best and most cost effective service to patients.

Logics of marginalisation in health and social care reform:integration, choice, and provider-blind provision

The period 2010–2013 was a time of far-reaching structural reforms of the National Health Service in England. Of particular interest in this paper is the way in which radical critiques of the reform process were marginalised by pragmatic concerns about how to maintain the market-competition thrust of the reforms while avoiding potential fragmentation. We draw on the Essex school of political discourse theory and develop a ‘nodal’ analytical framework to argue that widespread and repeated appeals to a narrative of choice-based integrated care served to take the fragmentation ‘sting’ out of radical critiques of the pro-competition reform process. This served to marginalise alternative visions of health and social care, and to pre-empt the contestation of a key norm in the provision of health care that is closely associated with the notions of ‘any willing provider’ and ‘any qualified provider’: provider-blind provision.

The process of coping in King-Kopetzky Syndrome

Our object was to describe the process of coping in King-Kopetzky syndrome and hypothesise how the process is mediated. We used a qualitative study using open-ended interviews. The data were gathered purposefully from 19 cases in the first phase of the study. Accounts were then compared deductively with six accounts from a previous interview-based study. Maximum contrast was sought in cases and in experience of clinical interventions. Participants were recruited from Hearing Therapy services in Bath and North East Somerset Primary Care Trust and The Welsh Hearing Institute. Interviews were conducted in participants’ homes or clinic setting. Coping was determined by the concept that the individual developed about their hearing difficulties. The process of conceptualizing involves reconciling the symptoms experienced with the information obtained from clinicians. The process is mediated by the context in which hearing difficulties occur and the interventions that are received. Forming a coherent concept of hearing difficulties facilitates coping. Clinicians can assist this process by giving patients with King-Kopetzky Syndrome an explanation of the condition.

'Girls who do Boys like they’re girls'? Exploring the role of gender in the junior management of contemporary service work

This article attempts to explain the clustering of women managers at junior managerial grades in the service sector by focusing on the structuring and organization of work in a call centre. The article is based on an ethnography of an organization and seeks to contribute to the ongoing debate in gender research by exploring and documenting the requirement for the enactment of masculinities at work for successful managers. Central to our account is the role of team leader which, as a junior management position, occupies a key role in understanding and accounting for the gendered hierarchical terrain of contemporary service-based organizations. In exploring the role of team leader, a position that tends overwhelmingly to be held by female staff, we draw attention to the perception of the gendered nature of the role by subordinate members of the organization, the team-leaders themselves and more senior managers. The position is also brought into sharp relief in comparison with the subordinate role of the ‘problem manager’, a position overwhelmingly held by men.

The evaluation of information systems in the organisational context of the National Health Service. Available in 2 volumes.

This thesis describes a project which has investigated the evaluation of information systems. The work took place in, and is related to, a specific organisational context, that of the National Health Service (NHS). It aims to increase understanding of the evaluation which takes place in the service and the way in which this is affected by the NHS environment. It also investigates the issues which surround some important types of evaluation and their use in this context. The first stage of the project was a postal survey in which respondents were asked to describe the evaluation which took place in their authorities and to give their opinions about it. This was used to give an overview of the practice of IS evaluation in the NHS and to identify its uses and the problems experienced. Three important types of evaluation were then examined in more detail by means of action research studies. One of these dealt with the selection and purchase of a large hospital information system. The study took the form of an evaluation of the procurement process, and examined the methods used and the influence of organisational factors. The other studies are concerned with post-implementation evaluation, and examine the choice of an evaluation approach as well as its application. One was an evaluation of a community health system which had been operational for some time but was of doubtful value, and suffered from a number of problems. The situation was explored by means of a study of the costs and benefits of the system. The remaining study was the initial review of a system which was used in the administration of a Breast Screening Service. The service itself was also newly operational and the relationship between the service and the system was of interest.

The role of attributions in reactions to job relocation

Job relocation refers to the process of simultaneously moving to a new job and house and this can cause considerable stress for the relocator and his/her family. Based upon an attributional analysis, we predicted that negative psychological reactions would be a function of (1) number of relocation problems, and (2) making pessimistic attributions for relocation problems (that is, the tendency to attribute negative events to internal, stable and global causes). Furthermore, these factors should interact, such that individuals with many relocation problems who also make pessimistic attributions will experience the worst psychological reactions. The results from a cross-sectional survey of 93 relocators supported these predictions. As expected, those relocators who had many relocation problems and made pessimistic attributions reported the worst mental health and relocation-specific stress. In addition, a reanalysis of a longitudinal study of relocators by Martin (1996) also supported the above predictions using attributions of perceived control. Furthermore, the relocators predicted to be most at risk (many problems}/low control) reported the worst changes in mental health during the course of the move.

Enzymatic production of oligosaccharides in centrifugal fields

The aims of this work have been to identify an enzymatic reaction system suitable to investigate and develop the high-speed centrifuge as a novel reaction system for performing such reactions. The production of galacto-oligosaccharides by the trans-galactosyl activity of the enzyme β-galactosidase on lactose monohydrate was identified as a model enzymatic system to elucidate the principles of this type of process. Galacto-oligosaccharides have attracted considerable commercial interest as food additives which have been shown to be beneficial to the health of the human gastrointestinal tract. The development of a single unit operation capable of controlling the biosynthesis of galacto-oligosaccharides whilst simultaneously separating the enzyme from the reaction products would reduce downstream processing costs. This thesis shows for the first time that by using a combination of (a) immobilised or insolubilised β-galactosidase , (b) a rate-zonal centrifugation technique, and (c) various applied centrifugal fields, that a high-speed centrifuge could be used to control the formation of galacto-oligosaccharides whilst removing the enzyme from the reaction products. By layering a suspension of insolubilised β-galactosidase on top of a lactose monohydrate density gradient and centrifuging, the applied centrifugal fields generated produced sedimentation of the enzyme particles through the substrate. The higher sedimentation rate of the enzyme compared to those of the reaction products allowed for separation to take place. Complete sedimentation, or pelleting of the enzyme permits the possible recovery and re-use. Insolubilisation of the enzyme allowed it to be sedimented through the substrate gradient using much lower applied centrifugal fields than that required to sediment free soluble enzyme and this allowed for less expensive centrifugation equipment to be used. Using free soluble and insolubilised β-galactosidase stirred-batch reactions were performed to investigate the kinetics of lactose monohydrate hydrolysis and galacto-oligosaccharide formation. Based on these results a preliminary mathematical model based on Michaelis-Menten kinetics was produced. It was found that the enzyme insolubilisation process using a chemical cross-linking agent did not affect the process of galacto-oligosaccharide formation. Centrifugation experiments were performed and it was found that by varying the applied centrifugal fields that the yield of galacto-oligosaccharides could be controlled. The higher the applied centrifugal fields the lower the yield of galacto-oligosaccharides. By increasing the applied centrifugal fields the 'contact time' between the sedimenting enzyme and the substrate was reduced, which produced lower yields. A novel technique involving pulsing the insolubilised enzyme through the substrate gradient was developed and this was found to produce higher yields of galacto-oligosaccharide compared to using a single enzyme loading equivalent to the total combined activity of the pulses. Comparison of the galacto-oligosaccharide yields between stirred-batch and centrifugation reactions showed that the applied centrifugal fields did not adversely affect the transgalactosyl activity of the insolubilised enzyme.

Multiple paradigms and organisational research: an analysis of work behaviour in the fire service

The thesis examines Kuhn's (1962, 1970) concept of paradigm, assesses how it is employed for mapping intellectual terrain in the social sciences, and evaluates it's use in research based on multiple theory positions. In so doing it rejects both the theses of total paradigm 'incommensurability' (Kuhn, 1962), and also of liberal 'translation' (Popper, 1970), in favour of a middle ground through the 'language-game of everyday life' (Wittgenstein, 1953). The thesis ultimately argues for the possibility of being 'trained-into' new paradigms, given the premise that 'unorganised experience cannot order perception' (Phillips, 1977). In conducting multiple paradigm research the analysis uses the Burrell and Morgan (1979) model for examining the work organisation of a large provincial fire Service. This analysis accounts for firstly, a 'functionalist' assessment of work design, demonstrating inter alia the decrease in reported motivation with length of service; secondly, an 'interpretive' portrayal of the daily accomplishment of task routines, highlighting the discretionary and negotiated nature of the day's events; thirdly, a 'radical humanist' analysis of workplace ideology, demonstrating the hegemonic role of officer training practices; and finally, a 'radical structuralist' description of the labour process, focusing on the establishment of a 'normal working day'. Although the argument is made for the possibility of conducting multiple paradigm research, the conclusion stresses the many institutional pressures serving to offset development.

The interaction between the implementation of an occupational health and safety management system and safety culture:a case study in the rubber industry

A prominent theme emerging in Occupational Health and Safety (OSH) is the development of management systems. A range of interventions, according to a prescribed route detailed by one of the management systems, can be introduced into an organisation with some expectation of improved OSH performance. This thesis attempts to identify the key influencing factors that may impact upon the process of introducing interventions, (according to B88800: 1996, Guide to Implementing Occupational Health and Safety Management Systems) into an organisation. To help identify these influencing factors a review of possible models from the sphere of Total Quality Management (TQM) was undertaken and the most suitable TQM model selected for development and use in aSH. By anchoring the aSH model's development in the reviewed literature a range ofeare, medium and low level influencing factors were identified. This model was developed in conjunction with the research data generated within the case study organisation (rubber manufacturer) and applied to the organisation. The key finding was that the implementation of an OSH intervention was dependant upon three broad vectors of influence. These are the Incentive to introduce change within an organisation which refers to the drivers or motivators for OSH. Secondly the Ability within the management team to actually implement the changes refers to aspects, amongst others, such as leadership, commitment and perceptions of OSH. Ability is in turn itself influenced by the environment within which change is being introduced. TItis aspect of Receptivity refers to the history of the plant and characteristics of the workforce. Aspects within Receptivity include workforce profile and organisational policies amongst others. It was found that the TQM model selected and developed for an OSH management system intervention did explain the core influencing factors and their impact upon OSH performance. It was found that within the organisation the results that may have been expected from implementation of BS8800:1996 were not realised. The OSH model highlighted that given the organisation's starting point, a poor appreciation of the human factors of OSH, gave little reward for implementation of an OSH management system. In addition it was found that general organisational culture can effectively suffocate any attempts to generate a proactive safety culture.

The operation of repair in L2 learner conversation, group work and classroom discourse

The present study is an empirical investigation into repair in spoken discourse, specifically focusing on L2 learner conversation, group work and teacher-fronted classroom interaction. The core of the investigation concentrates on identification of the problem type, classification of repair strategies and examination of interaction in the repair process. A comparison between Conversation (CS), Group Work (GW), and Teacher-fronted classroom interaction (CR) suggests that more repair is undertaken in CS. The results of the study suggest that the fundamental differences between CS, GW and CR are of two types: in the frequency of repair and in the nature of the repair itself. It has been found that other-initiation for production problem repair occurs mainly in CR, other-completion is characteristic of GW and self-repair is most frequent in CS. Factors affecting the occurrence of repair in CS, GW and CR are related to content and social and communicative features of context. Importantly, the study shows the frequency of repair in GW falls between that of CS and CR in most of repair strategies. This result lends support to the argument that group work can assist L2 learners to develop their communicative competence. It is suggested that the analysis of the repair process in CS, GW and CR can be useful in throwing light on the intricacies of spoken discourse in general and can be exploited by applied linguists for both theoretical and pedagogical purposes.

Retinal and systemic vascular function in health and disease: the effect of smoking and coronary artery disease

The purpose of the following studies was to explore the effect of systemic vascular and endothelial dysfunction upon the ocular circulation and functionality of the retina. There are 6 principal sections to the present work. Retinal vessel activity in smokers and non-smokers: the principal findings of this work were: chronic smoking affects retinal vessel motion at baseline and during stimulation with flickering light; chronic smoking leads to a vaso-constrictory shift in retinal arteriolar reactivity to flicker; retinal arteriolar elasticity is decreased in chronic smokers. The effect of acute smoking on retinal vessel dynamics in smokers and non-smokers: the principal finding of this work was that retinal reactivity in chronic smokers is blunted when exposed to clicker light provocation immediately after smoking one cigarette. Ocular blood flow in coronary artery disease: The principal findings of this work were: retrobulbar and retinal blood flow is preserved in CAD patients, despite a change pulse wave transmission; arterial retinal response to flickering light provocation is significantly delayed in CAD patients; retinal venular diameters are significantly dilated in CAD patients. Autonomic nervous system function and peripheral circulation in CAD: The principal findings in this work were: CAD patients demonstrate a sympathetic overdrive during a 24 period; a delay in peripheral vascular reactivity (nail-fold capillaries) as observed in patients suffering from CAD could be caused by either arteriosclerotic changes of the vascular walls or due to systemic haemodynamic changes. Visual function in CAD: The principal findings in this work were: overall visual function in CAD patients is preserved, despite a decrease in contrast sensitivity; applying a filtering technique selecting those with greater coefficient of variance which in turn represents a decrease in reliability, some patients appear to have an impaired visual function as assessed using FDT visual field evaluation. Multiple functional, structural and biochemical vascular endothelial dysfunctions in patients suffering from CAD: relationships and possible implications: The principal findings of this work were: BMI significantly correlated with vWF (a marker of endothelial function) in CAD patients. Retinal vascular reactivity showed a significant correlation with peripheral reactivity parameters in controls which lacked in the CAD group and could reflect a loss in vascular endothelial integrity; visual field parameters as assessed by frequency doubling technology were strongly related with systemic vascular elasticity (ambulatory arterial stiffness index) in controls but not CAD patients.

Doctoral work in translation studies as an interdisciplinary mutual learning process:how a translator, teacher educator and linguistic typologist worked together

The focus of this paper is on the doctoral research training experienced by one of the authors and the ways in which the diverse linguistic and disciplinary perspectives of her two supervisors (co-authors of this paper) mediated the completion of her study. The doctoral candidate is a professional translator/interpreter and translation teacher. The paper describes why and how she identified her research area and then focused on the major research questions in collaboration with her two supervisors, who brought their differing perspectives from the field of linguistics to this translation research, even though they are not translators by profession or disciplinary background and do not speak Korean. In addition, the discussion considers the focus, purpose and theoretical orientation of the research itself (which addressed questions of readability in translated English-Korean texts through detailed analysis of a corpus and implications for professional translator training) as well as the supervisory and conceptual processes and practices involved. The authors contend that doctoral research of this kind can be seen as a mutual learning process and that inter-disciplinary research can make a contribution not only to the development of rigorous research in the field of translation studies but also to the other disciplinary fields involved.

Illusions of team working in health care

Purpose: The ubiquity and value of teams in healthcare are well acknowledged. However, in practice, healthcare teams vary dramatically in their structures and effectiveness in ways that can damage team processes and patient outcomes. The aim of this paper is to highlight these characteristics and to extrapolate several important aspects of teamwork that have a powerful impact on team effectiveness across healthcare contexts. Design/methodology/approach: The paper draws upon the literature from health services management and organisational behaviour to provide an overview of the current science of healthcare teams. Findings: Underpinned by the input-process-output framework of team effectiveness, team composition, team task, and organisational support are viewed as critical inputs that influence key team processes including team objectives, leadership and reflexivity, which in turn impact staff and patient outcomes. Team training interventions and care pathways can facilitate more effective interdisciplinary teamwork. Originality/value: The paper argues that the prevalence of the term "team" in healthcare makes the synthesis and advancement of the scientific understanding of healthcare teams a challenge. Future research therefore needs to better define the fundamental characteristics of teams in studies in order to ensure that findings based on real teams, rather than pseudo-like groups, are accumulated. © Emerald Group Publishing Limited.

Investigating the process of translation:humour translation norms, strategies and approaches in children's literature

Research in the present thesis is focused on the norms, strategies,and approaches which translators employ when translating humour in Children's Literature from English into Greek. It is based on process-oriented descriptive translation studies, since the focus is on investigating the process of translation. Viewing translation as a cognitive process and a problem soling activity, this thesis Think-aloud protocols (TAPs) in order to investigate translator's minds. As it is not possible to directly observe the human mind at work, an attempt is made to ask the translators themselves to reveal their mental processes in real time by verbalising their thoughts while carrying out a translation task involving humour. In this study, thirty participants at three different levels of expertise in translation competence, i.e. tn beginner, ten competent, and ten experts translators, were requested to translate two humourous extracts from the fictional diary novel The Secret Diary of Adrian Mole, Aged 13 ¾ by Sue Townsend (1982) from English into Greek. As they translated, they were asked to verbalise their thoughts and reason them, whenever possible, so that their strategies and approaches could be detected, and that subsequently, the norms that govern these strategies and approaches could be revealed. The thesis consists of four parts: the introduction, the literature review, the study, and the conclusion, and is developed in eleven chapters. the introduction contextualises the study within translation studies (TS) and presents its rationale, research questions, aims, and significance. Chapters 1 to 7 present an extensive and inclusive literature review identifying the principles axioms that guide and inform the study. In these seven chapters the following areas are critically introduced: Children's literature (Chapter 1), Children's Literature Translation (Chapter 2), Norms in Children's Literature (Chapter 3), Strategies in Children's Literature (Chapter 4), Humour in Children's Literature Translation (Chapter 5), Development of Translation Competence (Chapter 6), and Translation Process Research (Chapter 7). In Chapters 8 - 11 the fieldwork is described in detail. the piolot and the man study are described with a reference to he environments and setting, the participants, the research -observer, the data and its analysis, and limitations of the study. The findings of the study are presented and analysed in Chapter 9. Three models are then suggested for systematising translators' norms, strategies, and approaches, thus, filling the existing gap in the field. Pedagogical norms (e.g. appropriateness/correctness, famililarity, simplicity, comprehensibility, and toning down), literary norms (e.g. sound of language and fluency). and source-text norms (e.g. equivalence) were revealed to b the most prominent general and specific norms governing the translators'  strategies and approaches in the process of translating humour in ChL. The data also revealed that monitoring and communication strategies (e.g. additions, omissions, and exoticism) were the prevalent strategies employed by translators. In Chapter 10 the main findings and outcomes of a potential secondary benefit (beneficial outcomes) are discussed on the basis of the research questions and aims of the study, and implications of the study are tackled in Chapter 11. In the conclusion, suggestions for future directions are given and final remarks noted.